Emergency Neurology

Question 1

Examples of:

a) acute prolonged severe vertigo
b) recurrent spontaneous attacks
c) recurrent positionally triggered attacks
d) chronic persistent dizziness

Answer 1

a) vestibular neuronitis, stroke (brainstem/ cerebellum), demyelinating disease
b) Meniere disease, vestibular migraine, transient ischemic attacks
c) benign paroxysmal positional vertigo
d) psychogenic, cerebellar ataxia

A

Question 2

Useful features in establishing the cause of dizziness

Answer 2

1) time course (acute prolonged severe vertigo, recurrent spontaneous attacks, recurrent positionally triggered attacks, chronic persistent dizziness)
2) Provoking factors (change in position, change in blood pressure)
3) Aggrevating factors (head movement/ if head movement does not worsen dizziness it is probably not vertigo)

A

Question 3

Features suggesting central versus peripheral cause of vertigo

Answer 3

A

+ HINTS test

Question 4

Common disorders under the term dizziness

Answer 4

1) Vertigo
2) Presyncope
3) Disequilibrium
4) Non-specific dizziness

A

Question 5

Causes of vertigo

Answer 5

B

Question 6

Clinical features of common causes of vertigo

Answer 6

B

Question 7

When is neuroimaging indicated in vertigo?

Answer 7

1) if the examination is not entirely consistent with a peripheral lesion
2) if there are prominent risk factors for stroke
3) if there are neurologic signs or symptoms
4) if the patient cannot walk
5) if there is a new headache accompanying the vertigo

B

Question 8

Anatomic Classification of Coma

Answer 8

C

Question 9

Common Causes of Coma

Answer 9

C

Table 6.2 (@ Evernote)

Question 10

Checklist for the evaluation of acute coma

Answer 10

C

Question 11

Main treatable causes of acute coma and their treatment

Answer 11

C

Question 12

Syncope:
A) Definition
B) Underlying mechanism

Answer 12

A) Syncope is a transient loss of consciousness associated with loss of postural tone, followed quickly by a spontaneous return to baseline neurologic function requiring no resuscitative efforts

B) The underlying mechanism is global hypoperfusion of both the cerebral cortices or focal hypoperfusion of the reticular activating system

D

Question 13

Major life threatning causes of syncope

Answer 13

D

Question 14

Common causes of syncope

Answer 14

D

Question 15

High- and low-risk factors in syncope patients

Answer 15

Table 3

D

Question 16

History suggestive of vasovagal syncope

Answer 16

Prodrome phase: slow, progressive that may include some combination of dizziness or lightheadedness, a sense of warmth, pallor, nausea and vomiting, abdominal pain, changes in vision, or diaphoresis

Assosciation with precipitating event: eg micturition or defecation syncope, situational syncope (eg, while having blood drawn), or cough-mediated syncope

D

Question 17

Examples of neurologic syncope

Answer 17

• subarachnoid hemorrhage
• transient ischemic attack (stroke and transient ischemic attacks generally cause focal
• neurologic deficits that do not recover rapidly or completely)
• subclavian steal syndrome
• complex migraine headache
• autonomic failure

D

Question 18

Factors suggestive of seizure (Vs syncope)

Answer 18

• Prodrome (aura) different from that described for vasodepressor syncope
• Eye deviation, usually superiorly and/or laterally
• Episode of abrupt onset associated with injury
• Presence of a tonic phase before the onset of rhythmic clonic activity
• Head deviation or unusual posturing during the episode
• Tongue biting (particularly involving the lateral aspect of the tongue)
• Loss of bladder or bowel control
• Prolonged post-event (postictal) phase during which the patient is confused and disoriented

D + E

Question 19

1) Orthostatic hypotension diagnosis and
2) Warning signs of autonomic failure

(in the evaluation of the patient with syncope)

Answer 19

1) 
Intermittent determination by sphygmomanometer of BP and HR while supine and during active standing for 3 min are indicated at initial syncope evaluation
Abnormal BP fall is defined as a progressive and sustained fall in systolic BP from baseline value >20 mmHg or diastolic BP >10 mmHg, or a decrease in systolic BP to <90mmHg
2) 
- early impotence 
- disturbed micturition
- hyposmia 
- rapid eye movement sleep behaviour disorders
- Parkinsonism 
- ataxia 
- cognitive impairment 
- sensory deficits

E

Question 20

Ictal asystole and syncope

Answer 20

Ictal asystole is the case when epileptic seizures trigger syncope
Ictal bradycardia and asystole occur in 0.3–0.5% of seizures
Bradycardia precedes asystole and AV block may occur
Epileptic asystole occurs during partial complex seizures, not during generalized seizures
Epileptic asystole occurs in only a fraction of the seizures of one person, and then occurs after a variable interval of 5–100 s from seizure onset.
If asystole lasts for more than about 8 s, syncope ensues.
Ictal bradycardia, asystole, and ictal AV block are likely self-terminating
Therapy requires anti-epileptic drugs and possibly a pacemaker
Ictal asystole is probably not involved in sudden death in epilepsy

E

Question 21

Status epilepticus definition

Answer 21

Prolonged or rapidly recurring convulsions lasting more than 5 min

F

Question 22

When should a lumbar puncture performed in a patient with seizures?
What is important to do before?

Answer 22

A lumbar puncture should be performed in febrile patients and when there is suspicion of central nervous system infection or subarachnoid hemorrhage

Preferably after obtaining the CT scan

F

Question 23

Status Epilepticus checklist for the first hour

Answer 23

F

Question 24

Ειδικές περιπτώσεις κατά την αντιμετώπιση Status Epilepticus

Answer 24